Silesian Genealogical Society

Membership Application Form

Forename (s)   ..........................................................................................................................

Surname   .................................................................................................................................

Maiden name   ........................................................................................................................

Date of birth   ..........................................................................................................................

Address   .................................................................................................................................

   ................................................................................................................................................

e-mail    .....................................................................................................................................

http://   .....................................................................................................................................

Tel.    ........................................................................................................................................

Language (s)   .........................................................................................................................

Research subject (families of my ancestors)   ...................................................................

   ................................................................................................................................................
I wish to become a ordinary (benefit*) member of the Silesian Genealogical Society.
I send my membership dues of   ....................   for the year   ..........................
by postal order  to the following address:

Silesian Genealogical Society
ul. Dubois 3/1  
PL-50-208 Wroclaw

Date   ........................................     Signature   .......................................................................

We, the parents, allow our son (daughter*) to be enrolled as a member of the Silesian Genealogical Society.

                                                                 ....................................................................
                                                                               signatures of parents

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Update: February 2005

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